| NPI | 1801181219 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223X2210X Dentist, Orofacial Pain (Licence: KY 9528) |
| Additional Taxonomies | 122300000X Dentist (Licence: KY 9528) |
| 125Q00000X Oral Medicinist (Licence: KY 9528) | |
| Enumeration Date | 2011-06-14 |
| Last Update Date | 2019-10-21 |